Diabetes Footcare

Definition/Description

Keeping people mobile, independent, in work and at home has wider health and economic benefits. Podiatrists reduce the impact of disability and dysfunction and support rehabilitation. They are experts in the synthesis of tissue viability and biomechanics, which makes them uniquely skilled to understand the impact of weight bearing pressure on foot structures affected by; surgery, diabetes, arthropathies, vascular disease or musculoskeletal (MSK) issues. They play a pivotal role in reducing the risk of amputation, infection, pain, deformity and hospital admissions.

CHCP Hull & East Riding Podiatry Service provides Assessment, diagnosis and management for eligible patients within various clinic locations across Hull and East Riding and domiciliary visits for those meeting the housebound criteria.

The Podiatry Service operates Monday to Friday: 08:00 – 20:00hrs (excluding Bank Holidays) – actual opening times vary from base to base.

The Podiatry services offered include:  

  • Diabetic foot ulcer management including Multidisciplinary foot team
  • Wound care for all foot ulcerations
  • Foot protection services for those at risk of limb loss.
  • Musculoskeletal assessment and management (Hull 5 – 13 years and ERY over 5 years)
  • Nail surgery with phenolisation age 12 years and over .

The service will work with patients and their carers to provide advice and guidance on all aspects of their care, promote independence and help delay deterioration and reduce the risk of avoidable hospital admission.

Red Flag Symptoms

Patients presenting with signs of SEPSIS should be advised to seek urgent medical attention by attending A & E, minor injuries or contacting 111.

Patients presenting with: Night sweats, significant weight loss, significant trauma with immediate symptoms, bladder or bowel disturbances, complete loss of sensation, reduced power, gait disturbances or medically unstable should be advised to seek urgent medical attention by attending A & E or contacting 111.

DO NOT REFER

  • Medically unstable patients requiring hospital admission ie sepsis, immediate medical care should be commenced.
  • Low to moderate risk Diabetic foot – advise on self care
  • Children under 5 years of age
  • Non painful MSK conditions
  • Asymptomatic, developmental paediatric conditions e.g. flat feet, in toeing, curly toes.
  • Patients requiring footwear, splints and walking aids
  • Patients requiring steroid injections
  • Patients considering foot surgery other than toe nail avulsion.
  • Patients unsuitable for nail surgery within community setting under local anaesthesia ie those requiring sedation.
  • Hypermobility as primary diagnosis that are asymptomatic, and/or without specific MSK problem
  • Under 12 years requiring toe nail surgery
  • MSK referrals for over 13 years in Hull
  • Leg wounds above the ankle – please refer to CHCP community nursing team
  • Fungal nail infections not requiring surgery
  • Verrucae

Guidelines on Management

Intervention: Notes:

Diabetic foot Emergenc
  • Ulceration. All ulcers should be referred to the MDFT within 24 hours
  • Acute Charcot foot. People with diabetes and neuropathy who develop unexplained inflammation of the foot should be assumed to have an acute Charcot foot and referred for urgent assessment by the MDFT
Foot protection services for those classified as high Risk of Limb Loss
  • Patients should be encouraged to manage their own foot health needs when safe to do so, including maintaining good skin and nail care. Please direct patients to CHCP Podiatry web page for advice and guidance on good Diabetic foot care. Patients with neuropathy should be advised to self care with caution, check feet regularly for wounds or trauma and discouraged from walking barefoot. They should receive annual foot checks within their Diabetes review, provided with advice on signs and symptoms of a Diabetic foot emergency and how to access urgent podiatry via tel: 247111 or CHCP Podiatry website
  • Peripheral arterial disease without ulceration. Patients with no foot wound and symptomatic peripheral arterial disease should be referred via ERS to vascular services for triage and management.
  • Painful peripheral neuropathy. Guidelines for the management of painful neuropathy have been published (NICE CG173 'Neuropathic pain in adults: pharmacological management in non-specialist settings' and SIGN 116 'Management of diabetes') and this can be supervised in general practice, provided that the GP is confident that the neuropathy is the cause of the pain.
  • Disease of the foot unrelated to diabetes. Symptoms or signs of other diseases including dermatological conditions, venous insufficiency, inflammatory arthritis should be managed appropriately within primary care and referred to podiatry only if they are at high risk of ulceration
Foot Ulceration LLP ( non-diabetics)

Patients with painful and or infected nails suitable for minor surgery within a community clinic. Referring clinicians should advise patients Podiatry perform nail avulsion with phenolisation under local anaesthetic. Suitable patients must be 12 years or and willing to have surgical removal of part or all of the nail. Average healing times are 8 – 12 weeks.

Exclusions:

Patients with known previous adverse reaction to local anaesthetic

Patients with peripheral arterial disease

Patients with unstable Hypertension

Patients with HbA1c over 75mmol/mol – Blood Glucose levels should be optimised prior to considering surgery to improve healing potential.

Patients on immunosuppressants unless agreed with consultant and medications optimised

under 12 years due to licensing of local anaesthetic.

Requests purely for cosmetic purposes.

Patients requiring sedation due to needle phobias etc.
MSK

Painful musculoskeletal foot conditions only, please avoid referring simple MSK problems with a duration of symptoms less than 3-6 weeks. The vast majority will resolve with simple advice, analgesia and exercises that can be provided in primary care. Alternatively defer the patient to CHCP MSK services website where clear advice, resources and rehab for MSK conditions can be found (www.chcpmsk.org.uk).

Exclusions

Referrals for therapeutic footwear, ankle or foot splints these should be directed to the orthotics service.

Children under 5 years of age should be managed by the Humber childrens centre or specialist paediatric services. hnf-tr.childrensphysio@nhs.net

Toe walkers or in-toeing gait as diagnosis, Developmental Coordination Disorder, Developmental Delay. These referrals should be directed to Humber NHS Service hnf-tr.childrensphysio@nhs.net

Please note: Humber children’s service does not see toe walkers without additional issues.

Hull patients over 13 years of age should be referred to MSK Health share. Healthshare Hull is the MSK Single Point of Access (SPA) service for Hull GP registered patients with muscle and joint pain. Integrated with a Level 2 Advanced MSK Physiotherapist service including efficient one stop shop model working with diagnostic pathways, point of care MSK sonography, landmark and image guided cortisone injections, a digital platform supporting self-care with ability to flex to F2F appointments and exercise interventions in supervised 1-1, group and digital formats.

All Orthopaedic referrals (red flags excluded) should be directed through Healthshare Hull to ensure all locally agreed surgical thresholds are fulfilled and conservative care has been exhausted

 

Referral Criteria/Information

Any foot wound below the ankle requires urgent referral within 1 working day

General podiatry nail and callus care for patients at high risk of limb loss only. Those not meeting the criteria should be advised on self care.

MSK referrals over 5 years in ERY 5 – 13 years in Hull

Painful nails requiring nail surgery (over 12 years only)

GP/HCP via  Completed referral forms will be accepted via:

SystmOne to SystmOne, email to: chcp.247111@nhs.net or ERS

Telephone contact for urgent referrals or escalations : 01482 247111 ( self referral & Health professional)

All referrals are processed by CHCP care coordination team. Urgents will be processed within 1 working day. Routine referrals will be sent an invite to book into a telephone triage assessment appointment.

Appointments will be made direct with the patient. Clinics are held at various locations across the East Riding and Hull area.

Home visits are available and subject to criteria

Information to include

Podiatry referrals should contain enough relevant information to enable us to make a triage decision as to how the patient is best managed, without us needing to examine their medical records, or return the referral to you requesting further information. The following details should always be included where possible:

  • Reason for referral
  • Relevant medical / social history including HbA1c results and other appropriate investigations and results.

Associated Policies

There are no associated policies.

Specialties

Diabetes Hull Diabetes East Riding

Places covered by

  • East Riding
  • Hull

Hospital Trusts

Author:
Date created: 07/07/2025, 08:43
Last modified: 15/07/2025, 10:29
Date of review: 07/07/2027